Childhood tuberculosis in high burden settings.
Childhood tuberculosis in high burden settings.
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DOI：
10.1016/j.ebiom.2020.103181
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发表时间：
2021-01
期刊：
影响因子：
11.1
通讯作者：
Togun T
中科院分区：
文献类型：
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作者：
Togun T
据估计，全球每年发生100万例15岁以下儿童结核病病例，其中约四分之一将死于结核病。大多数儿童结核病病例和死亡发生在低收入和中等收入国家，在这些国家，困难和延误，主要是结核病病例发现方面的困难和延误，导致儿童健康状况不佳。儿童结核病是少菌性的，获得高质量的痰标本是一项挑战，特别是在非常年轻的儿童中。此外，儿童结核病的临床表现类似于其他常见的儿童疾病，如艾滋病毒、肺炎、病毒性和细菌性血液感染以及营养不良。因此，开发能够快速可靠地诊断儿童结核病的新型非痰液诊断工具以及优化现有诊断工具显然是一项迫切需要。在2019冠状病毒病综合征之前，观察到低收入和中等收入国家疫苗可预防感染的发病率和死亡率有所下降。这可归因于免疫接种和疫苗覆盖率的提高，并突出了结核病作为儿童疾病和死亡的可预防和可治疗原因的相对重要性。诊断儿童结核病的现有困难，加上COVID-19的出现对结核病控制服务构成新的挑战，是实现第三项可持续发展目标（SDG-3）和世界卫生组织（世卫组织）“终止结核病战略”的主要威胁。儿童最常在接触患有传染性结核病的成人后获得结核病感染，疾病进展和死亡的风险很高。作为应对COVID-19公共卫生措施的一部分，许多结核病流行国家实施了严格的封锁措施，这可能导致更多家庭儿童接触传染性结核病指数病例。此外，在结核病高负担环境中，COVID-19导致常规结核病诊断和治疗服务的可及性大幅减少，包括接触者追踪活动。因此，需要共同努力，通过宣传、政策参与和增加对转化研究的资助来减轻这种影响。这些研究将包括这些
An estimated one million cases of tuberculosis (TB) occur globally each year in children younger than 15 years, approximately a quarter of whom will die from TB [1]. The majority of the childhood TB cases and deaths occur in low-and middle-income countries (LMIC), where difficulties and delays, principally in TB case detection, contribute to poor outcomes in children [2]. Childhood TB is paucibacillary and obtaining good quality sputum specimen is a challenge, particularly in the very young. In addition, the clinical presentation of TB in children mimics other common childhood diseases such as HIV, pneumonia, viral and bacterial blood infection and malnutrition. Therefore, the development of novel non-sputum-based diagnostic tools that could give a rapid and reliable diagnosis of TB in children as well as the optimisation of the currently available diagnostic tools are a clear critical need. Prior to the COVID-19 syndemic [3], reductions in morbidity and mortality from vaccine-preventable infections in LMIC were observed. These were attributable to improvements in immunisation and vaccines coverage, and highlighted the relative importance of TB as a preventable and treatable cause of childhood disease and death [4]. The existing difficulty in diagnosing TB in children, coupled with the emergence of COVID-19 as a new challenge to TB control services, are major threats to achieving the third Sustainable Development Goal (SDG-3) and the ‘End TB Strategy’of the World Health Organization (WHO)[5].Children most often acquire TB infection following exposure to adults with infectious TB disease, with a high risk of progression to disease and death. The strict lockdown measures imposed as part of the public health response to COVID-19 in many TB endemic countries have the potential to result in more household exposure of children to infectious TB index cases. In addition, COVID-19 has resulted in significant reductions in access to routine TB diagnosis and treatment services, including contact tracing activities, in high TB burden settings. Therefore, concerted efforts will be required to mitigate this impact through advocacy, policy engagement, and increased funding for translational research studies. Such studies will include those